28043例新生儿听力筛查结果分析

The analysis of 28 043 cases of neonatal hearing screening

目的探讨新生儿听力障碍的发生情况及高危因素,以便早期干预治疗。方法采用耳声发射仪和(或)自动听性脑干反应对28043例新生儿进行听力筛查及复查,复筛未通过者利用脑干听觉诱发电位仪进行听力障碍诊断。结果3年总出生新生儿28405例,可筛总数28369例,实际筛查28043例,其中3201例因各种原因在新生儿科治疗(高危组),余无明确高危因素(正常组)。初筛率98.85%,初筛未通过率6.39%(1792/28043);应复查1792例,实际复查1183例,复查率66.01%,复查未通过率13.01%(154/1183);进行诊断患儿150例,其中70例出现不同程度听力损伤,听力损伤的发生率为2.4‰(70/28043),其中轻度损伤29例(41.4%),中度损伤25例(35.7%),重度损伤18例(12.9%),极重度损伤7例(10.0%)。正常组听力损伤检出率1.89‰,高危组检出率1.03%,高危儿听力损伤的发生率(33/3201)明显高于正常新生儿,两者比较有显著性差异(P﹤0.05)。分析33例高危儿发现早产、窒息、出生缺陷等可能与听力损伤有关。结论对所有新生婴儿应常规进行新生儿听力筛查,加强宣教,增加复筛率,早期发现,早期治疗。耳声发射仪联合自动听性脑干反应能提高高危儿听力损伤的诊断率。听力损伤的发生病因复杂,在将高危因素的患儿列为重点筛查对象的同时,对所有婴儿均应进行必要的监测,以减少儿童永久性听力损伤的发生率。

Objective To investigate incidence and high-risk factors of congenital hearing loss and explore feasible screening methods. Methods To analyze the data of hearing screening in 28 043 cases of newborn infants during 2004-2006. Results A total of 28 369 newborns was available but 28 043 newborns （98.85%） were for initial screening before discharge from hospital The neonates who failed in the first screening were 6.39%, the second failed grades were 13.01%. The rate of neonatal congenital hearing loss was 2.4‰, and mild, moderate, severe and profound grade were 41.4%, 35.7%, 12.9%, 10.0% respectively. There was significant difference in neonatal hearing loss incidence between normal infants and infants with high-risk factors, and infants with high-risk factors would induce more neonatal hearing loss. Premature delivery, neonatal asphyxia, birth abnormality were associated with neonatal hearing loss. Condusious Routine hearing screening is necessary. The incidence of congenital hearing loss is more higher in neonatal infants with high-risk factors. OAE and AABR are good methods to screen infants with high-risk factors of hearing loss, It is very important to monitor the abnormal infants.